Jejunal diverticula bleeding: A challenging diagnosis entity

Abstract

Jejunal diverticula (JD) bleeding is an uncommon but clinically significant cause of lower gastrointestinal bleeding (LGIB), representing a diagnostic and therapeutic challenge due to its rarity, nonspecific symptoms, and frequent overlap with colonic diverticular disease. While diverticulosis predominantly affects the colon, JD—often asymptomatic—carry a higher risk of severe complications, including massive hemorrhage. This review synthesizes current evidence on the epidemiology, risk factors, pathogenesis, clinical presentation, diagnostic approach, and management of JD bleeding. Jejunal diverticulosis occurs most commonly in older patients and frequently coexists with diverticula in other segments of the gastrointestinal tract. Risk factors include age, male sex, obesity, smoking, alcohol consumption, connective tissue abnormalities, and alterations in intestinal neuromuscular performance. Bleeding results from erosion or rupture of the vasa recta running over the diverticular dome. Clinically, patients may present with painless hematochezia, anemia, or hemodynamic instability. Diagnosis is often delayed, requiring a combination of colonoscopy, computed tomography angiography, capsule endoscopy, and, in selected cases, angiography. Although most diverticular bleeding episodes resolve spontaneously, endoscopic hemostasis remains the first-line treatment when feasible, while angiographic embolization and surgery are reserved for refractory or severe cases. Early recognition and precise localization of the bleeding source are essential to reduce morbidity and mortality. This review underscores the importance of considering JD as a potential source of bleeding in patients with obscure or recurrent LGIB and highlights the need for individualized, multidisciplinary management strategies.

Keywords: Diverticula; Diverticulitis; Jejunum; Gastrointestinal bleeding; Inflammation; Pathophysiology

Core Tip: Jejunal diverticula (JD) predominantly affects older patients, with higher prevalence observed in Western populations. Most cases are discovered incidentally during imaging studies or autopsy, as clinical manifestations ranging from abdominal pain to melena are often nonspecific and may mimic other gastrointestinal conditions. The pathogenesis of JD is multifactorial, involving increased intraluminal pressure, bowel wall weakness, gut dysbiosis, low fiber intake, and possible genetic predispositions. Jejunal diverticulosis is frequently misdiagnosed due to vague presentation and diagnostic limitations. Therefore, early recognition and appropriate management are essential to reduce morbidity and prevent life-threatening outcomes.